Mehdi Hasan: Renationalise the railways? Please do.

Will Self triumphs on BBC Question Time.

My fellow New Statesman columnist - and the new professor of contemporary thought at Brunel University - Will Self put in a typically brilliant performance on BBC1's Question Time last night, especially on the subject of rail privatisation.

He interrupted a rambling answer from fellow QT panellist and Conservative cabinet minister Eric Pickes to say:

I merely seek to observe that the [rail] subsidy was £1 billion before [when] they were nationalised, in real terms, and it's now £4 billion.

He continued:

The fundamental mistake - and there were many mistakes about the privatisation of the rail system - but the most fundamental mistake was rail travel, your journey to work, is not a fungible good and that means it cannot be exchanged for anything else. You can't get to Guildford station and think: 'Oh I want go to work in London today. I'll go to Mars on this new rocket train that's been provided by this splendid private company'.

It was a ludicrous idea from the get-go and the particular way that they did it with the track hived off from the rail operators has caused absolute chaos, some dreadful crashes and the current predicament that you find yourselves in.

"So what would you do?" asked Pickles. Self replied, to huge applause from the Surrey audience:

I'd renationalise it.

The 16-year rail privatisation experiment has been an utter disaster. Above-inflation increases in UK train fares - that are now the highest in western Europe - make it more and more unpopular as time goes by. Tory ministers, their cheerleaders in the right-wing press and their Blairite fellow-travellers in the Labour Party often forget - or choose to ignore! - that there is a clear majority in favour of renationalisation of the railways - on the left and the right. The inconvenient truth for ministers is that the likes of Bob Crow - and Will Self! - are more in touch with voters than they are. And the recent row over multi-million-pound, taxpayer-funded Network Rail bonuses - which were eventually and reluctantly waived by Network Rail bosses after public outcry - didn't do the privatisation cause much good. It was another reminder of how messed up the system is.

In fact, as transport expert Christian Wolmar wrote back in October 2008, a month after the start of the financial crisis:

[W]hat New Labour refuses to let on is that the railways are effectively largely publicly-owned anyway. Network Rail, which owns the infrastructure, is a company without shareholders that is dependent on government backed debt (to the tune of £20bn), for its survival. It receives billions in annual grants direct from government and is, to all intents and purposes, a state-run enterprise.

Wolmar also pointed out that with Network Rail already in public hands, it would cost little or nothing to "renationalise them", once the train operators decided to hand back their franchises when their terms expired or once they got into financial difficulties.

This isn't just an ideological or political argument; it's financial. A recent study by the Transport for Quality of Life thinktank found that renationalisation could save the taxpayer £1.2 billion a year "through cheaper borrowing costs, removing shareholders' dividends and reducing fragmentation". £300 million alone, said the study, would be saved if train operating companies were taken into public ownership.

It's a no-brainer: the time has come to renationalise the railways. It would be a popular, effective and money-saving move in our current "age of austerity". Ed Miliband and Maria Eagle - are you listening?

Mehdi Hasan is a contributing writer for the New Statesman and the co-author of Ed: The Milibands and the Making of a Labour Leader. He was the New Statesman's senior editor (politics) from 2009-12.

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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage